CONTEXT AND OBJECTIVE: Venous thrombosis occurs as a result of interaction of genetic and acquired factors including activated protein C resistance (APC-R), fibrinogen levels, antithrombin, protein C, protein S, lupus anticoagulants and anticardiolipin antibodies. This study was aimed at determining the prevalence of these common thrombophilia markers in Asian Indians with primary venous thrombosis. DESIGN AND SETTING: This was a cross-sectional study carried out in Mumbai. METHODS: Samples from 78 patients with a confirmed diagnosis of venous thrombosis and 50 controls were tested. Semi-quantitative estimation (functional assays) of protein C, protein S and antithrombin was performed. Quantitative estimation of fibrinogen was done using the Clauss method. Lupus anticoagulants were screened using lupus-sensitive activated partial thromboplastin time and β2-glycoprotein-I dependent anticardiolipin antibodies were estimated by ELISA. APC-R was measured using a clotting-based method with factor V deficient plasma and Crotalus viridis venom. Statistical analysis was performed using Epi-info (version 6). RESULTS: The popliteal vein was the most commonly involved site. Forty-four samples (56%) gave abnormal results. The commonest were elevated fibrinogen and APC-R (17.9% each), followed by low protein S (16.6%). CONCLUSIONS: This study confirms the literature findings that fibrinogen level estimation and screening for APC-R are important for the work-up on venous thrombosis patients since these, singly or in combination, may lead to a primary thrombotic episode. The frequency of the other thrombophilia markers was higher among the patients than among the controls, but without statistically significant difference.

Presence of antibodies against human leukocyte antigen (HLA) molecules, which may be may be directed against HLA class I or/and class II antigens, is a known risk factor for acute rejections and graft loss. Pre-transplantation panel reactive antibody (PRA) estimation is done to identify sensitized patients prior to solid organ transplantation and also forms the basis of cadaver organ allocation. The aim of this study is to evaluate the PRA in 52 patients awaiting first renal transplant, identify various factors contributing to high PRA, and observe its influence on graft survival. This was a case control study performed in a tertiary care hospital. Eighty-five samples including 63 from 52 patients with end-stage renal disease (ESRD), 10 from healthy volunteers, and 12 from presumed sensitized individuals were tested for class I and/or II PRA by enzyme-linked immunosorbent assay (ELISA) using Quik ID ® GTI kits. PRA for both class I and II was zero in all healthy controls and 19/46 (37%) patient samples; while individually, PRA class I and II were zero in 32/60 (53%) and 39/45 (86.3%) samples, respectively. PRA exceeded 10% in 16 samples from 12 patients with peak class I and II PRA of 100% and 46%, respectively. Post-transplantation, 27/31 patients are doing well, while four died with a functioning graft. Patient reactivity to antigen stimulation is the most important factor determining the PRA levels, and class I PRA is more relevant for detection of sensitization in first-time recipients and adversely affects the graft outcome.

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Background: Since 2014 Luminex crossmatch (LXM) is being performed regularly in India for post-transplant management of renal allograft recipients. Aim: This study was planned to evaluate the possible role of the LXM in the post-transplant setting for the detection and characterization of HLA-specific IgG antibodies and to correlate with allograft biopsy and renal function. Methods: A retrospective study was performed on 169 consecutive LXM performed at a single center to investigate suspected allograft dysfunction (n=147) and for monitoring DSA in normally functioning allografts (n=22). A total of 116 biopsies (including 11 repeats) and 40 panel reactive antibody (PRA) screen tests were performed. Results: Donor specific antibodies (DSA) were detected in 81 samples (47.9%): 7 recipients had HLA class I DSA alone, 56 had only HLA class II DSA and 18 recipients had both. First time biopsies were categorized as: negative for rejection (n=30), antibody mediated rejection (n=32), acute cellular rejection (n=23), chronic rejection (n=15) and dual morphology (n=5). LXM was positive in 44/75 biopsies with rejection and transiently raised in 11/30 recipients who showed no evidence of rejection. On the basis of the LXM results biopsy was not performed in 42 recipients who showed improved renal function 15 recipients with non-specific findings on first biopsy. Conclusion: The study suggests that LXM is useful and economically viable algorithm for the detection of antibodies in the post-transplant work up of renal allograft recipients in developing nations.

APL, positive family history and smoking were significantly associated with stroke in the young. We advocate screening for APL in all young patients with stroke.